Safety and Feasibility of Transcaval Access for the Delivery of Impella Microaxial Flow Pump.

Background: Transcaval access (TCA) may enable percutaneous mechanical circulatory support (MCS) with reduced risk of vascular complications in cardiogenic shock patients needing mechanical support. Methods: This single-center retrospective study included patients who underwent TCA placement of an Impella 5.0 (Abiomed) from June 2015 to March 2023. Data on demographic characteristics, clinical, procedural variables, and in-hospital outcomes were collected. Results: Seventy-two patients (mean age, 58.2 years; 66.7% men) were included. Twenty-eight patients had nonischemic cardiomyopathy and 43 had ischemic cardiomyopathy, with a baseline left ventricular ejection fraction of 23.5% ± 14.2%. Most patients (90.3%) were in categories C to E of the Society for Cardiovascular Angiography & Interventions (SCAI) classification for cardiogenic shock. TCA and MCS delivery were successful in all cases. Forty-two patients survived to explant device and TCA sheath, with successful explant in 36 using nitinol occluders; 7 needed a covered stent due to underlying right ventricular dysfunction to avoid right ventricular failure. Overall, in-hospital survival was 44.4%, with 43.8% in the nonischemic group and 56.2% in the ischemic group. Bleeding Academic Research Consortium (BARC) bleeding >1 occurred in 13.9%. No vascular complications from the access site were observed. During hospitalization, 16.7% had ventricular tachycardia/ventricular fibrillation and 5.6% had pulseless electrical activity postimplantation. Acute kidney injury requiring hemodialysis occurred in 15.3%, and 4.2% had a stroke. The average length of stay was 19.9 days (IQR, 3-28.25). Conclusions: Transcaval access for Impella 5.0 is safe and feasible in experienced hands for patients needing advanced MCS due to inadequate peripheral arterial access or insufficient support from conventional devices.